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Oklahoma State Department of Health
1000 N.E. 10th, Oklahoma City, OK 73117
TEL: 405-271-5600 or 1-800-522-0203
www.ok.gov/health / Email: webmaster@health.ok.gov
RECOMMENDED ACTIONS FOR HEALTHCARE FACILITIES BY MEDICAL EMERGENCY EVENT STAGE
GREEN
BLUE
YELLOW
ORANGE
RED
Moderate to high potential exists for medical emergency
These listed measures may be taken:
Administration/Planning
• Establish and maintain emergency notification list of key personnel.
• Discuss at facility and regional level contingencies for scarce resource situations [see AHRQ document Mass Medical Care with Scarce Resources at www.ahrq.gov/research/mce/], including involvement of ethics committee members, administration, and medical staff on a facility Clinical Care Committee that will determine which services may be offered during an emergency.
• Conduct Continuity of Operations Planning (COOP) for all hazards situations - assume schools may be out and staff may need housing during emergency.
• Develop security plans for buildings including augmentation of staff and ingress/egress control.
• Stockpile personal protective equipment and create contingencies for when supplies run low.
• Plan for surge capacity, including accommodating patients in non-traditional areas both on-site and off-site.
• Contact local public health agencies and area hospitals to formulate regional plans for capacity, including alternate care sites, as determined by regional needs.
• Encourage employees to have personal emergency plans in place, including emergency day-care arrangements and family communications.
Operations
• Stress good infection control practices
Pre-Training/Education (Pre-Event)
• Encourage personal preparedness planning using www.ready.gov information.
• Provide all hazards response education to employees and fit-test personnel, and/or have ability to provide just-in-time fit testing for N95 or other appropriate respirators and/or PPE.
• Conduct exercises to practice preparedness responses; stress long-term response and incident action planning cycles consistent with Hospital Incident Command System (HICS) and National Incident Management System (NIMS).
• Develop and provide JIT cross training for staff that may be utilized in other clinical areas.
Indication of impending medical emergency
In addition to the previously listed measures, the following steps may be taken:
Administration/Planning
• Cancel or deny employee travel/leave, as appropriate.
• Conduct education about staff protection and expectations.
• Activate clinical care committee to examine situation and determine when and how to change services provided (e.g., canceling elective surgeries / appointments) based on the severity and expected arrival time of the emergency. Determine triggers to move from this level to yellow level and further adaptive strategies when this occurs.
• Track financial impact (direct and indirect) and staff time carefully for reimbursement.
Communications
• Communicate plans and expectations to clinical and business units, as well as to patients and families.
• Coordinate staff and public messages with community and regional leaders and partners.
Operations
• Partially activate the Hospital Command Center; begin daily action planning cycle and information updates.
• Have staff wear personal protective equipment (PPE) when treating suspect cases and place in isolation room, per infection control recommendations.
• Separate suspect cases in emergency departments (ED) and clinics; follow OSDH case definitions and protocols. Provide masks to all suspect cases and post signage for patients regarding respiratory hygiene.
• Review elective procedures and cancel if patient recovery will be impacted by emergency.
• Assess supplies and vendor inventory, place orders as needed; communicate with partner agencies about supply needs.
• Screen patients and visitors prior to building entry, assigning infectious or suspect cases to appropriate care areas with appropriate PPE and respiratory hygiene.
Training/Education (Pre-Event)
• Conduct just-in-time (JIT) education for employees, including fit testing when required. Work with public health agencies and hospitals to craft public messages about symptoms and when (and when not) to come to hospital/clinics.
• Develop and provide JIT training on selected aspects of clinical care.
Initial impact recognized
In addition to the previously listed measures, the following steps may be taken:
Administration/Planning
• Have Clinical Care Committee determine (on daily basis) which (if any) modifications in facility services are necessary. Conduct appropriate case-finding and reporting.
• Open staff housing areas, as needed; open auxiliary rest, clinical care, and family areas, as needed.
• Begin limiting non-urgent surgeries and procedures.
• Implement access controls and institute visitor and family member policies according to institutional procedures.
Communications
• Communicate on a daily basis among hospitals and agencies (e.g., through conference calls).
• Conduct employee and public information campaigns; update daily.
Operations
• Isolate or cohort cases in ED, clinics, and in-patient units.
• Determine whether staff wears PPE for all patient encounters in addition to suspect cases.
• Determine whether visitors/staff presenting to facility should wear PPE.
• Determine if changes should be made to visitation policy.
Widespread impact apparent
In addition to the previously listed measures, the following steps may be taken:
Administration/Planning
• Have Clinical Care Committee determine each day the administrative and clinical changes needed to cope with demand for resources; this may include appointment of triage team to decide which patients receive certain therapies (e.g., ventilators), based on prognosis; conduct bed management to move beds and patients with authority of administration.
• Set up Multi-Agency Coordination (MAC) with public health agencies, other hospitals, and EMS; determine when to open on-site and/or off-site alternate care sites, as needed and as staffing and resources are available.
Communications
• Update hospital employees and the public regularly on what services the hospital is offering. When should patients come to the hospital? What can they do at home?
Operations
• Fully activate Hospital Command Center with action-planning cycles for next operational period.
• Mask all patients and visitors presenting to facility; staff wear PPE continuously to prevent exposure.
• Triage use of ED, clinic, and in-patient resources as required (e.g., what conditions will be evaluated in the ED? What surgeries will be done today?)
Overwhelming impact beyond capacity of healthcare system
In addition to the previously listed
measures, the following steps may
be taken:
Administration/Planning
• Triage team appointed by clinical care committee makes medical allocation decisions. Clinical Care Committee continues to make daily decisions about which hospital services can be maintained. Cohorting of patients no longer possible – emphasis on respiratory hygiene and PPE, based on clinical situations and ethical standards.
Communications
• Staff, patient, and patient / provider family behavioral health and security issues become critical to assure support and safety.
• Update the hospital employees and the public regularly on what services the hospital is offering. When should patients come to the hospital? What can they do at home?
Operations
• Work with area hospitals, clinics, and public health to open alternate care sites when possible to reduce burden on hospitals, based on clinical situations and ethical standards.
• Concentrate critical care in hospitals; work with homecare and public health to assure appropriate homecare instructions given.

Oklahoma State Department of Health
1000 N.E. 10th, Oklahoma City, OK 73117
TEL: 405-271-5600 or 1-800-522-0203
www.ok.gov/health / Email: webmaster@health.ok.gov
RECOMMENDED ACTIONS FOR HEALTHCARE FACILITIES BY MEDICAL EMERGENCY EVENT STAGE
GREEN
BLUE
YELLOW
ORANGE
RED
Moderate to high potential exists for medical emergency
These listed measures may be taken:
Administration/Planning
• Establish and maintain emergency notification list of key personnel.
• Discuss at facility and regional level contingencies for scarce resource situations [see AHRQ document Mass Medical Care with Scarce Resources at www.ahrq.gov/research/mce/], including involvement of ethics committee members, administration, and medical staff on a facility Clinical Care Committee that will determine which services may be offered during an emergency.
• Conduct Continuity of Operations Planning (COOP) for all hazards situations - assume schools may be out and staff may need housing during emergency.
• Develop security plans for buildings including augmentation of staff and ingress/egress control.
• Stockpile personal protective equipment and create contingencies for when supplies run low.
• Plan for surge capacity, including accommodating patients in non-traditional areas both on-site and off-site.
• Contact local public health agencies and area hospitals to formulate regional plans for capacity, including alternate care sites, as determined by regional needs.
• Encourage employees to have personal emergency plans in place, including emergency day-care arrangements and family communications.
Operations
• Stress good infection control practices
Pre-Training/Education (Pre-Event)
• Encourage personal preparedness planning using www.ready.gov information.
• Provide all hazards response education to employees and fit-test personnel, and/or have ability to provide just-in-time fit testing for N95 or other appropriate respirators and/or PPE.
• Conduct exercises to practice preparedness responses; stress long-term response and incident action planning cycles consistent with Hospital Incident Command System (HICS) and National Incident Management System (NIMS).
• Develop and provide JIT cross training for staff that may be utilized in other clinical areas.
Indication of impending medical emergency
In addition to the previously listed measures, the following steps may be taken:
Administration/Planning
• Cancel or deny employee travel/leave, as appropriate.
• Conduct education about staff protection and expectations.
• Activate clinical care committee to examine situation and determine when and how to change services provided (e.g., canceling elective surgeries / appointments) based on the severity and expected arrival time of the emergency. Determine triggers to move from this level to yellow level and further adaptive strategies when this occurs.
• Track financial impact (direct and indirect) and staff time carefully for reimbursement.
Communications
• Communicate plans and expectations to clinical and business units, as well as to patients and families.
• Coordinate staff and public messages with community and regional leaders and partners.
Operations
• Partially activate the Hospital Command Center; begin daily action planning cycle and information updates.
• Have staff wear personal protective equipment (PPE) when treating suspect cases and place in isolation room, per infection control recommendations.
• Separate suspect cases in emergency departments (ED) and clinics; follow OSDH case definitions and protocols. Provide masks to all suspect cases and post signage for patients regarding respiratory hygiene.
• Review elective procedures and cancel if patient recovery will be impacted by emergency.
• Assess supplies and vendor inventory, place orders as needed; communicate with partner agencies about supply needs.
• Screen patients and visitors prior to building entry, assigning infectious or suspect cases to appropriate care areas with appropriate PPE and respiratory hygiene.
Training/Education (Pre-Event)
• Conduct just-in-time (JIT) education for employees, including fit testing when required. Work with public health agencies and hospitals to craft public messages about symptoms and when (and when not) to come to hospital/clinics.
• Develop and provide JIT training on selected aspects of clinical care.
Initial impact recognized
In addition to the previously listed measures, the following steps may be taken:
Administration/Planning
• Have Clinical Care Committee determine (on daily basis) which (if any) modifications in facility services are necessary. Conduct appropriate case-finding and reporting.
• Open staff housing areas, as needed; open auxiliary rest, clinical care, and family areas, as needed.
• Begin limiting non-urgent surgeries and procedures.
• Implement access controls and institute visitor and family member policies according to institutional procedures.
Communications
• Communicate on a daily basis among hospitals and agencies (e.g., through conference calls).
• Conduct employee and public information campaigns; update daily.
Operations
• Isolate or cohort cases in ED, clinics, and in-patient units.
• Determine whether staff wears PPE for all patient encounters in addition to suspect cases.
• Determine whether visitors/staff presenting to facility should wear PPE.
• Determine if changes should be made to visitation policy.
Widespread impact apparent
In addition to the previously listed measures, the following steps may be taken:
Administration/Planning
• Have Clinical Care Committee determine each day the administrative and clinical changes needed to cope with demand for resources; this may include appointment of triage team to decide which patients receive certain therapies (e.g., ventilators), based on prognosis; conduct bed management to move beds and patients with authority of administration.
• Set up Multi-Agency Coordination (MAC) with public health agencies, other hospitals, and EMS; determine when to open on-site and/or off-site alternate care sites, as needed and as staffing and resources are available.
Communications
• Update hospital employees and the public regularly on what services the hospital is offering. When should patients come to the hospital? What can they do at home?
Operations
• Fully activate Hospital Command Center with action-planning cycles for next operational period.
• Mask all patients and visitors presenting to facility; staff wear PPE continuously to prevent exposure.
• Triage use of ED, clinic, and in-patient resources as required (e.g., what conditions will be evaluated in the ED? What surgeries will be done today?)
Overwhelming impact beyond capacity of healthcare system
In addition to the previously listed
measures, the following steps may
be taken:
Administration/Planning
• Triage team appointed by clinical care committee makes medical allocation decisions. Clinical Care Committee continues to make daily decisions about which hospital services can be maintained. Cohorting of patients no longer possible – emphasis on respiratory hygiene and PPE, based on clinical situations and ethical standards.
Communications
• Staff, patient, and patient / provider family behavioral health and security issues become critical to assure support and safety.
• Update the hospital employees and the public regularly on what services the hospital is offering. When should patients come to the hospital? What can they do at home?
Operations
• Work with area hospitals, clinics, and public health to open alternate care sites when possible to reduce burden on hospitals, based on clinical situations and ethical standards.
• Concentrate critical care in hospitals; work with homecare and public health to assure appropriate homecare instructions given.